1993, 07-06 Permit App: 93005469 SewerLfSal7� .Ga35 ci3-946r
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SEWER CONNECTION PERMIT APPLICATION FORM
*THIS APPLICATION
FORM
WIMUST
NBE FILBE LED
OUT
ED. ACCURATELY AND IN ITS ENTIRETY
AND SIGNED
(IF KNOWN)
JOB ADDRESS: Ilej - z�PARCEL NUMBER:�----
CITY: �—
�r�; STATE: - ZIP CODE:
OWNER NAME: 7- ADDRESS:
PHONE: -2 5 -'2
�--
CITY: -/ �^ STATE:
lC
PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? (CIRCLE 0YES D '
*IF PROPERTY OWNER INSTALLING SEWER, THEY MUST FIRST CONTACT THE UTILITIES
DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT IS ISSUED.
—E-1—coq—OR IiAU.EV WR'� IttV6
CONTRACTOR: C.tRCNAINE EXC.
ZATION ADDRESS: 8�J
Vca d�ai c W fa S+*T gQo3 PHONE: Q?U_ Fll
STATE CONTRACTORS LICENSE NUMBER-•'
COU2.CQt o-1 9-
UTILITIES INSTALLERS PERMIT NUMBER:
INTERIOR PLUMBING ALTERATIONS? YES NO (CIRCLE ONE)
INTERIOR ALTERATION WORK BY..:
PHONE'-
CITY:
HONE:
ADDRESS:
CITY:
STATE: ZIP CODE:
*ONE PERMIT REQUIRED FOR EACH SEPARATE BUILDING, SHOP, GARAGE, ETC
THAT WILL BE cOjjjvECT'CO TO THE SFWFP..
.cry
SEWER CONNECTION .............: #OF BUILDINGS
/ x 50.00
=
INTERIOR PLUMBING ALTERRTIONS: # OF BUILDINGS X 35.00� C �
TOTAL PERMIT FEE DUE $
APPLICANT
SIGNATURE
SPOKANE COUNTY DEPARTMENT OF BUILDINGS
WEST 1026 BROADWAY AVENUE SPOKANE,WA 99260 (509)456-3675